Safe at School with Diabetes PowerPoint PPT Presentation

Incidence of Type 1 DM. ADA-23.6 million people in US with Diabetes (7.8% of population)3 million of those people have Type 1 Diabetes1 in 400/600 children have Type 1 DiabetesJDRF

Copyright Complaint Adult Content Flag as Inappropriate

Download Presentation

Safe at School with Diabetes

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

Presentation Transcript

2. Incidence of Type 1 DM ADA-23.6 million people in US with Diabetes (7.8% of population)
3 million of those people have Type 1 Diabetes
1 in 400/600 children have Type 1 Diabetes
JDRF – 15,000 people are diagnosed with Type 1 diabetes every year
That’s 40 people per day!
Incidence of Diabetes has doubled in the past 20 years
? 3% per year
Some increase is recognized in patients being diagnosed during winter months

3. Type 1 Diabetes Occurs most often in children but can be diagnosed in adulthood
Auto immune condition
Most common auto immune condition in children
Causes are still unknown-MULTIFACTORAL
Insulin producing cells in pancreas are destroyed by antibodies - hormone deficiency
Requires insulin injections to sustain life
“Hormone Replacement Therapy”

4. The Evolution of Diabetes Care 1980’s = One or 2 shots per day with none at school
1990’s = 2-3 shots per day with none at school
Later 1990’s = New insulin analogs that led to implementing intensive regimens 3-4 shots per day
2000 = 24 hour basal insulin = before meal and snacks fast acting and bedtime basal dose of insulin. Increase in CSII (Pump) in children of all ages.

5. Understanding Insulin Action

6. Flexible Insulin Therapy Children give injections with meals based on an insulin/ carbohydrate ratio – will be individualized
1unit per 15 grams of carbohydrate
1unit per 8 grams of carbohydrate
Correction dose of insulin is then applied to that ratio
0.5 unit for every 50 over 150 mg/dl – Target = 120 mg/dl
1.0 unit for every 30 over 130 mg/dl – Target = 100 mg/dl
Basal insulin used to cover fasting periods of the day
The same method used whether using injections or insulin pump

18. Cooperation-It takes a community Common Goal-Safe and Healthy Students
Define individual’s care/needs
Define what is medically necessary
Define roles of each partner
Achieve goal with available resources

19. Cooperation Each role equally important and dependent on the others
All team members adhere to IHP and roles
All team members want to or are willing to be part of the team (direct care)
Emergent call 24/7 to help with unusual events
IHP meetings/ 504 meetings if issues arise

24. Blood Sugar Monitoring Supervision of BG testing
May vary depending on age of child and how long they have had diabetes
Interpretation of BGs
Support for student to make decisions, not judgments
No good or bad numbers!!
One teen described BG testing as a pop quiz 4-6 times per day-she failed
Quit testing because of the negative feedback she kept getting
WORDS not ALLOWED in talking Diabetes Management with kids:
Non compliant
Non adherent
Brittle diabetes
Cheating
sneakingOne teen described BG testing as a pop quiz 4-6 times per day-she failed
Quit testing because of the negative feedback she kept getting
WORDS not ALLOWED in talking Diabetes Management with kids:
Non compliant
Non adherent
Brittle diabetes
Cheating
sneaking

27. Eating at school Safety- Meals-Lunch (Breakfast too?)
Carb counting accuracy-guesstimate
Supervision of what was eaten
Dose based on carbs consumed and pre-meal blood sugar
Serving sizes are standardized
Carb amounts on most Public school menus
Less flexibility at lunch (bag lunch)
+/- 15 grams will not make or break control target range=fluff As previously discussedAs previously discussed

29. Physical activity Safety All students are active at school or should be
Flexible insulin regimen allows for flexibility in activity with less frequency of low blood sugar reaction/compensation for unusual activity
Extra blood sugar checks for PE-individualized
Athletic participation- Athlete, trainer, coaches accountability – may need extra blood sugar checks during game/practice
School staff should be knowledgeable in treatment of low blood sugar reaction
Moderate/large ketones – should not be active regardless of blood sugar level

33. Effective diabetes management is crucial at school for the immediate safety of students with diabetes
for the long-term health of students with diabetes
to ensure that students with diabetes are ready to learn and to participate fully in school activities and
to minimize the possibility that diabetes-related emergencies will disrupt classroom activities

36. Why the Change?
MADISON — State Superintendent Tony Evers issued the following statement regarding Gov. Jim Doyle signing Senate Bill 414 into law.
“Governor Doyle and the Legislature understand that our student population and the nature of school nursing have changed over the years. The provisions of this law are important given the large number of people in the school setting that may have responsibilities for administering medications to students and the increasing proportion of students with special health care needs. With the school nurse to pupil ratio in Wisconsin averaging one nurse for every 2,359 pupils, it is increasingly important for school staff to be prepared and trained”.
Reference: Wisconsin Association of School Nurse
Legislation Action Center

37. Why the Change? “This law will enhance the health and safety of students by giving schools clear guidance as to what drugs can be administered to students, the instructions that must accompany those drugs, records that must be kept, the training required for those administering drugs, and the education requirements for school nurses”.
Reference: Wisconsin Association of School Nurse
Legislation Action Center

38. DPI statute 115.001 Definition of school Nurse
RN-licensed to practice in the state with a bachelor’s degree and/or
was employed by a school district before the bill was passed (grandfather clause) (or grandmother?)
Also includes state or federal money to improve nurse/student ratios and salariesAlso includes state or federal money to improve nurse/student ratios and salaries

39. DPI statute 118.29 Definition changes:
“Administer” means the direct application of a non-prescription drug product or prescription drug, whether by injection, ingestion or other means, to the human body

40. DPI statute 118.29 Medication Administration changes:
The civil liability exemption for administrators and school staff is now contingent on training occurring for all school staff administering medications to students. Does not apply to Health care professional (i.e. School Nurse)
Documentation of every dose and errors is required. No training and you administer meds you are liable and/or if a mistake is made.
Administrators are liable if they require a non-trained staff to administer medications.No training and you administer meds you are liable and/or if a mistake is made.
Administrators are liable if they require a non-trained staff to administer medications.

41. DPI statute 118.29 3. Glucagon may be administered by ANY staff person as long as they are trained and know the child has diabetes.
4. No employee except a health care professional may be required to administer a nonprescription drug or prescription drug to a pupil by any means other than ingestion.
You can’t force an employee to give medication via injection, rectally, unless you are a HCP.You can’t force an employee to give medication via injection, rectally, unless you are a HCP.

42. DPI statute 118.29 Written policies must be developed in consultation/assistance with one or more school nurses and must include record keeping, procedures, consents, storage, and be periodically reviewed by the school nurse.

43. DPI statute 118.29 6. Training- No school staff member may administer any drug to a pupil unless they have received training, approved by the department. This does not apply to health care professionals.
7. Schools must provide training either through the WI school meds on-line course and hands on training from a HCP, parent or through a district developed medication training program. If districts use their own program it must be approved by the DPI school nurse consultant. (will be in full effect on March 1, 2011.) Our diabetes training will still be needed at this point as the online tutorial does not cover insulin administration, hands-on training or diabetes info.
It does cover glucagon administration but not the hands on section.
Our diabetes training will still be needed at this point as the online tutorial does not cover insulin administration, hands-on training or diabetes info.
It does cover glucagon administration but not the hands on section.

44. What does this mean? State-wide consistency with basics of medication administration
State-wide development and monitoring of competencies for unlicensed assistive personnel
DPI owned- adherence to DMMP by school administrators
Less 504 meetings or more appropriate 504 meetings???

45. Diabetes Care in WI schools even safer? Basics of diabetes cares streamlined while providing for individual differences
Providers and school staff all on same page (everyone taught the same core information, using same forms, etc.)
Improves safety of students followed by PMD

46. Diabetes Program at CHW Offer multidisciplinary Comprehensive Care
Serve children 0-19 yrs of age
Nationally ADA Recognized Education Program in Milwaukee and Fox Valley
Serve over 1800 children with diabetes in Wisconsin, UP Michigan, and Northern Illinois
? 302 kids are in the Fox Valley
94% Type 1

47. CHW’s Role Provide school training regarding diabetes and how to care for students with diabetes at school
Provide support, resources, consultation for parents and district nurses regarding diabetes care issues May include IHP/DMMP care negotiation
Provide consultation/review as DPI develops a diabetes care in school program May include IHP/DMMP care negotiation
Provide consultation/review as DPI develops a diabetes care in school program

48. CHW-FV Diabetes Training for School Staff - 2010 Presented by: Tracey Haag. RN, BSN, CDE and Lainie Hintz, RD, CDE
AUDIENCE
This program is designed for nurses, school health care providers, and school staff involved in the diabetes care of students.
OBJECTIVES
Upon completing this course the school Health care provider will be able to:
Give an insulin injection Test blood sugars
Use an insulin pen Test urine ketones
Give a Glucagon injection Describe current diabetes care Count carbs in foods and drinks
PURPOSE
To teach school health care providers and staff to effectively manage and treat children with diabetes.
2010 Course Dates
January 29, 2010 February 26, 2010
March 19, 2010 April 23, 2010
August 13, 2010 September 24, 2010
October 22, 2010

49. CHW’s Role Involve/Coach the School Nurse or staff member
Be the Student’s advocate
“what does the student want to do”
What is in the student’s best interest
Goal is to minimize class disruption but provide safe care First question I ask
Often principal is unaware of larger diabetes in school program.First question I ask
Often principal is unaware of larger diabetes in school program.

50. Resources for WI School Nurses New School Nurse Orientation-survival skills for the first year (DPI and WASN sponsored) Oct 6, 2010 and Nov 3, 2010.
DAG –DPCP- Release of the updated “Students with Diabetes Resource guide for WI schools and families”
Use of standardized DMMP (IHP-Individual Health Plan) for all students with diabetes
Consistency = Safety DMMP=IHP we all worked on the development of the form
Consistency = SafetyDMMP=IHP we all worked on the development of the form
Consistency = Safety